NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 1

T

o stimulate information sharing and

internal collaborations and to identify

Divisional research goals, the Division

of Cancer Prevention (DCP) convened its

first-ever, staff-wide Scientific Advances

Symposium, February 4–5, 2003. Biomarker

nomenclature and identification, agent development, and energy balance were three of the

research opportunities targeted for additional

collaborations.

During a follow-up meeting on March 20,

Division Director Peter Greenwald, M.D., Dr.

P.H., further described DCP initiatives in

terms of the NCI’s challenge goal of eliminating suffering and death due to cancer by

2015. DCP’s leadership role in research in the

areas of early detection, prevention, and prediction was articulated. Strategic paths and

milestones through the processes of discovery,

development, and delivery were laid out for

the future.

Potential Divisional priorities that had

emerged from the two-day Symposium and

responses from individual staff surveys were

enumerated during the second meeting. These

were compiled into about thirty bulleted

points reflecting staff suggestions for scientific

opportunities and Divisional processes. Five

groups then assembled to concurrently discuss

the key crosscutting themes: biomarker

nomenclature, biomarker development, agent

development, enhancement of the agent

pipeline, and energy balance/obesity.

In the plenary session of the second meeting, each group reported its findings. The

Biomarker Nomenclature Group came up with

a team definition of “biomarker” as “an informative biological measurement/observation”

and offered these categories of biomarkers:

early detection; risk (acquired versus inherited);

effect (intermediate endpoint and surrogate

endpoint); and safety/toxicity. The Group recommended that NCI triage literature reviews

and reviews of existing NIH guidelines.

Division of Cancer Prevention’s Inaugural Scientific Advances

Symposium a Great Success

THE SAS PROJECT TEAM

IN THIS ISSUE

Division of Cancer Prevention’s

Inaugural Scientific Advances

Symposium a Great Success 1

Cancer Prevention and the 

All-Ireland-National Cancer

Institute Cancer Consortium 2

History of Cancer Prevention:

Alice Stewart, Cancer

Prevention Pioneer 3

Cancer Prevention 

Fellowship Program 4

Moving into the Era 

of Cancer Preemption 5

Staff Orientation 

Project Team 6

Results of the Prostate 

Cancer Prevention Trial 

with Finasteride 6

Exfoliated Cells, Bioactive 

Food Components, and Cancer

Prevention Workshop 7

DCP Awardees 8

PreventionPOST Credits 8

Transitions 9

Preventing Cancer: 

The Future of Cancer 

Nursing Practice 10

DCP Calendar of Events 11

September 2003

V O L UME 5/ISSUE 2

NEWSLETTER OF THE NCI DIVISION

OF CANCER PREVENTION

PreventionPOST

The first-ever staff-wide DCP Scientific Advances Symposium was held at the Bethesda Marriott in February.

Members of one of four breakout groups identify and

discuss Division Opportunities at the February SAS.

continued on page 5
2 PreventionPOST SEPTEMBER 2003

Cancer prevention research, training, and related health

promotion activities will soon benefit from an initiative

undertaken by a unique partnership—a consortium—

among the governments of Northern Ireland, Ireland, and the

United States. The All-Ireland-National Cancer Institute (NCI)

Cancer Consortium seeks to intensify cooperation among the

three participating countries in all aspects of cancer research,

treatment, and prevention. 

A Brief History of the Ireland-Northern IrelandNCI Cancer Consortium

In 1999, at a historic ceremony in Belfast’s

Stormont Castle, key government, scientific, and

medical leaders signed an agreement to work together to create a new cooperative approach to cancer (1). Programs in the

following key areas were to be developed through this cooperative group — the Ireland-Northern Ireland-NCI Cancer

Consortium: 

• Education and training

• Treatment and research

• Information dissemination

• Epidemiology

• Cancer prevention

• Surveillance

• Early detection

• Quality control

• Interactions aimed at enhanced public health and patient care

Initial efforts of the Consortium focused upon the establishment of a clinical trials network among cancer centers and

hospitals in Ireland and Northern Ireland, scholar exchange

and training between institutions in the three countries, information technology enhancements designed to enable collaboration on clinical trials, and data sharing and collaboration

among the island’s two cancer registries. An example of hightech information enhancement is the implementation of

TelesynergyTM at Belfast City Hospital and St. Luke’s Hospital

in Dublin. This multimedia medical imaging workstation system enables scientists at multiple locations to simultaneously

interact with one another. Recently, the cancer registries in the

north and the south cooperated to produce the first joint

report on incidence and mortality for the island of Ireland

(2,3). The Consortium has also created several unique training

opportunities, including a clinical trials training program for

oncology nurses, a cancer epidemiology fellowship program,

and a summer training program in cancer prevention and control. More information on these ongoing efforts can be found

on the Consortium’s website at www.allirelandnci.org.

Cancer Prevention Training and the 

All-Ireland-NCI Consortium 

Creating an infrastructure for cancer

prevention research activities is a longterm goal of the All-Ireland-NCI

Consortium. Building research capacity

requires a cadre of well-trained prevention research specialists. Training is

therefore crucial to the future of cancer

care and prevention in Ireland and is a

high priority for the Consortium. 

The Consortium’s support of the NCI’s Summer Curriculum

in Cancer Prevention is of special note. In the summers of

2001, 2002, and 2003, physicians, nurses, scientists, and public

health and health care professionals from Northern Ireland and

from the Republic of Ireland have attended the longstanding

courses on cancer prevention and control sponsored by the

NCI’s Division of Cancer Prevention. This summer Curriculum

is an integral part of a postdoctoral fellowship program at the

NCI—the Cancer Prevention Fellowship Program—and

includes a four-week course on the Principles and Practice of

Cancer Prevention and Control and a one-week course on

Molecular Prevention. These courses are designed to provide

state-of-the-art information on current research and practice

programs across the entire discipline of cancer prevention.

Funding for the summer training experience was provided by

the Health Research Board (Republic of Ireland) and by the

Research and Development Office (Northern Ireland). 

More information for these courses can be found on the

following websites: www.allirelandnci.org and

www3.cancer.gov/prevention/pob/courses.

All-Ireland Prevention Workshops: 

the Consortium’s Newest Initiative 

Consistent with the goal of the Consortium to enhance all

aspects of cancer prevention research, training, and related

health promotion activities across Ireland, a Prevention

Working Group was created; Dr. Douglas Weed of the NCI

serves as its chair. With broad membership from the scientific,

research, and policy communities, this newest Consortium

working group has as its mission to enhance coordination and

cooperation on cancer prevention on an all-island basis at all

levels—primary, secondary, and tertiary—through training,

strategy development and implementation, shared knowledge,

and monitoring mechanisms. Continuing support for the summer prevention training at the NCI is high on its list of priorities, but it has also decided that a series of All-Ireland Cancer

Prevention Workshops on the island is an important initiative.

The purpose of these workshops is to provide a forum for

bringing together physicians, nurses, scientists, and health 

Cancer Prevention and the All-Ireland-National Cancer Institute Cancer Consortium

DOUGLAS L. WEED

continued on page 12
NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 3

KATHLEEN FOSTER

Alice Stewart, Cancer Prevention Pioneer

1906-2002

“You need some resistance 

and criticism to bring out the

good work.”

Alice Stewart 

1906-2002 

Alice Stewart, a British epidemiologist, challenged the

establishment’s beliefs on radiation safety and was responsible for the prevention of untold

numbers of radiation-induced cancers, primarily childhood

leukemia. Born in Sheffield, England, in 1906, Alice was one

of eight children and a daughter of physician parents. Both

her mother and father were pediatricians practicing under the

Dickensonian conditions of overpopulated slums, crowded

orphanages, and rampant infectious disease. Her parents were

revered for their commitment to child welfare and for their

work to improve conditions in the community. Their example

made a lasting impression on Alice, who dedicated her life to

protecting the well-being of modern society through her

research on radiation-induced cancer.

Although distinguished as a clinician in her early career,

Stewart shifted her focus in 1941 when she joined Oxford

University to work for the government’s war effort. While

studying the health of munitions workers, she uncovered a

correlation between TNT exposure and the suppression of

blood cell formation. This success encouraged Stewart to redirect her energies towards epidemiology, then known as

social medicine. She joined the Institute of Social Medicine at

Oxford, where she pursued a lifelong interest in the causes of

childhood cancer. 

The 1950s may be remembered as an idyllic time of innocence compared to the global unrest of today’s news. However,

it was also an era defined by the arms race and the threat of a

nuclear holocaust. To offset public fears, the U.S. Atomic

Energy Commission (AEC) was launching an offensive of

another type. Their public relations campaign presented a

benign and accommodating image to the burgeoning nuclear

power industry. It promised that atomic power would be abundant and cheap, providing a road map to world peace. At the

same time, the emerging science of nuclear medicine was ready

to enthusiastically embrace atomic technology. Out of this

brave new world emerged such practices as the radiation of

infants with “enlarged” thymus glands, pelvimetry (the x-ray

of pregnant women to determine the size of their pelvis for

delivery), and the irradiation of adolescents for the treatment

of teenage acne. It was within this milieu that Stewart conducted her most important and controversial work.

Collaborating with statistician George Kneale, the pair collected data on childhood malignancies and their relationship to

family history, parental occupations and social class, infectious

diseases, and vaccination. In1956 their research led to the publication of the Oxford Survey of Childhood Cancer. This revolutionary report found that the children who died of cancer

had been subjected to x-rays in utero twice as often as healthy

children with no history of radiation exposure. Unfortunately,

this groundbreaking report was disregarded by radiologists of

the time, who continued the practice of x-raying pregnant

women until the 1970s.

As a result of her research in the munitions plants of the

1940s, Stewart maintained an interest in occupational health.

In 1974 she was invited to the U.S. to analyze the effects of

radiation on the health of nuclear workers at Hanford, in

Washington State. These workers had worked on the production of plutonium for the Manhattan Project, which led to

the creation of the atomic bomb. At that time radiation standards were obtained by extrapolating from data obtained on

Japanese who had survived the explosion of the atomic

bombs in Hiroshima and Nagasaki. However, Stewart’s

research contradicted these assumptions and instead found

that the workers’ cancer risk was about twenty times higher

than allowed for by international safety guidelines. The AEC

became alarmed by the implications of Stewart’s report and

tried to confiscate the data, forcing her to flee to England

with the study results. The Commission later challenged her

results, asserting that Hanford workers had a lower rate of

cancer than U.S citizens of comparable age. Stewart

explained that the AEC’s assessment was biased by the

“healthy worker effect,” a phenomenon similar to the one

allowing particularly resilient Japanese to survive their 

A-bomb exposure.

Stewart’s accomplishments reflect the multiple challenges

that she had to negotiate during her long and productive

career. Not only was she one of a vanguard of women physicians in a male-dominated profession, she also helped to

define the science of epidemiology. In an era that was celebrating the ascendancy of atomic energy, Stewart raised the alarm

concerning the management of this incredibly powerful

resource. Contrary to prevailing theories on radiation safety,

she collected the data that overwhelmingly supported her

hypothesis: there is no threshold below which radiation exposure is rendered harmless. Simply stated, the risk of cancer is

in direct proportion to the contact with radiation.

Throughout her long life Stewart combined a sense of social

responsibility with a desire to learn the causes of cancer and

ways to prevent it. One of her favorite sayings was “truth is

the daughter of time.” Although it took a lifetime of research,

Stewart succeeded in demonstrating the carcinogenic effects of

exposure to low-level radiation. This unpopular truth required

a major shift in the perception of nuclear power and full disclosure from the authorities that wielded that power.

Fortunately for public health, Alice Stewart persevered. ■

HISTORY OF CANCER PREVENTION
Congratulations to second-year fellow Lila J. Finney Rutten and

third-year fellow Mark Parascandola, who were each presented

with a Cancer Prevention Research Training Merit Award in June.

The Cancer Prevention Fellowship Program makes these awards

to recognize Cancer Prevention Fellows who are not only productive scientists but who have also performed noteworthy service

to the Program.

Third-year fellow Heather Poetschke Klug received the American

Association for Cancer Research–AFLAC Scholar-in-Training

Award at the AACR Mouse Models of Cancer Meeting held in

Lake Buena Vista, Florida, in February.

Fourth-year fellow David Berrigan won the Best Poster Award at

the Annual Meeting of the American Society of Preventive

Oncology held in Philadelphia in March.

Fourth-year fellow Jackie Lavigne was granted a Young

Investigator Fellowship Travel Award by the conference organizers to present a poster at the Eighteenth Annual Aspen Cancer

Conference in July.

ON THE PERSONAL SIDE

A W ARDS 

Special congratulations to Heather Poetschke Klug and her husband, David, on the birth of their daughter, Hannah Joy Klug, and

to Nomeli Nuñez and his wife, Katie, on the birth of their daughter, Veronica Ariela Nuñez. ■

By the end of the summer, thirteen second-year Cancer

Prevention Fellows are expected to have been awarded a Master

of Public Health degree and will have returned to NCI to launch

the mentored research projects that will occupy them for the next

two years. Returning fellows have received or will receive MPH

degrees from Johns Hopkins University (Marie Cantwell, PhD,

Yvonne Vargas, MD, and Katehrine Wasson, PhD), George

Washington University (Kenneth Hance, PhD, Tamaro Hudson,

PhD, and Larissa Korde, MD), Harvard University (Melinda S.

Kovacic Butsch, PhD, and Bernard Fuemmeler, PhD, MS), the

University of Pittsburgh (Connie Rogers, PhD, and Ashley Smith,

PhD), the University of Illinois–Chicago (Christine Holmberg,

PhD) and the University of Alabama–Birmingham (Martin

Whiteside, DC, PhD). In addition, four first-year fellows who

already held an MPH degree or had equivalent training in public

health came directly to NCI in June to begin their fellowships:

Laura E. Beane-Freeman, PhD, MS, Marla L. Clayman, PhD,

MPH, Aimee R. Kreimer, PhD, MS, and Julia Slutsman, PhD.

Drs. Slutsman and Wasson are the newest fellows to participate

in the Ethics of Prevention and Public Health Track, a specialty

track within the Cancer Prevention Program that was initiated in

July 2002.

In June incoming Cancer Prevention Fellows participated in a

six-day Orientation designed to help acclimate them to both the

NCI and to the Fellowship Program. Scheduled sessions included

a course in time management, training on the use of Microsoft

Outlook and the library online, help with “Plowing through

Paperwork,” and advice on how to get the best out of the

Fellowship. Fellows also had the opportunity to meet with potential research preceptors from the Division of Cancer Prevention;

the Division of Cancer Control and Population Sciences; the

Division of Cancer Epidemiology and Genetics; the Center for

Cancer Research; the Office of Science Planning and Assessment;

and the Office of Communication and Cancer Information

Products and Systems.

The Summer Curriculum in Cancer Prevention began on July 7

this year, with eighty-five researchers and clinicians attending the

eighteenth annual four-week summer lecture series on Principles

and Practice of Cancer Prevention and Control. Attendance at the

one-week Molecular Prevention Course in August will also comprise about eighty-five participants. Integrated with fifteen incoming Cancer Prevention Fellows and with researchers from both

within and outside NCI are registrants from all over the world.

The All-Ireland-NCI Cancer Consortium is sponsoring twentyseven attendees this year, with nine from Northern Ireland and

eighteen from the Republic. They are joined by seventeen additional international participants, with fifteen of these sponsored by

the Office of International Affairs/NCI.

The week before beginning the lecture course, fifteen incoming

Cancer Prevention Fellows participated in a two-day laboratory

At the Forefront of Training SUSAN N. PERKINS

4 PreventionPOST SEPTEMBER 2003

C ANCER PREVENTION FELLOWSHIP PROGRAM 

course, held in Building 60. This annual hands-on program is

designed to introduce fellows to some sophisticated but fundamental molecular biology techniques, such as the polymerase

chain reaction (PCR), DNA (Southern) blotting, and ELISAs and

other immunoassays. The primary objective of the lab is to help

the fellow who may be unfamiliar with these technologies by providing a laboratory experience that may give him or her greater

insights into these and other concepts when they are encountered

during the summer lecture series.

As usual, recruitment for the Cancer Prevention Fellowship

Program was busy this past spring and early summer. Ms. Susan

Winer (OPO) manned booths to promote the program at the

Johns Hopkins Bloomberg School of Public Health career fair and

at several professional meetings, including the Oncology Nursing

Society Meeting, the Digestive Diseases Week Meeting, the

American Society of Clinical Oncology Meeting, and the Cancer

Health Disparities Summit. The American Association for Cancer

Research Meeting, originally set for April in Toronto, Canada,

was postponed due to the Severe Acute Respiratory (SARS) outbreak and rescheduled for July in the new convention center in

Washington, D.C. ■
NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 5

NCI Director Andrew von Eschenbach

made his first personal visit to the

Division of Cancer Prevention on

March 12, 2003, to share his thoughts on the

mission, function, and structure of the

Institute. The session afforded representatives

from the Division the opportunity to highlight their research

focus and to reflect on key Division activities.

Dr. von Eschenbach began his visit with a casual reference

to his then-newly unveiled 2015 goal to end suffering and

death from cancer by that date by saying, “I’ve sort of sent

shockwaves through the cancer community recently.” He noted

that “for us to meet that challenge, this Division is smack in

the middle of the game,” adding that “we will be reaching out

to more effectively leverage what DCP does.”

Dr. von Eschenbach then provided an overview of his plans

for NCI, stating that he did not believe in the need for a strategic

plan but that he does believe in the need for reassessment. He

said, “The NCI is a volcano that has driven the biomedical

research enterprise from the 1971 enactment of the National

Cancer Act, and has continued with biomedical research exploding exponentially.” The great success story of the NCI is that it is

beginning to understand cancer as a disease process from population science to the era of molecular oncology. Advanced technology has afforded us the opportunity to better understand the

cancer process continuum from normal to malignant. “People

die with cancer because it goes to a lethal phenotype. The original tumor rarely has that lethality,” he said.

He said, “We are at a strategic inflection in biology, which

means a point of unprecedented growth in three key areas

related to cancer research: knowledge, technology, and

resources. It is the integration and growth of these three sectors

that provides for the exponential progress we have seen in the

past.” The Division of Cancer Prevention and its activities is

the keystone of this effort to broaden the scope of prevention

and move towards preemption.

After a year in office, the Director said he appreciates two

things every day: “What incredibly gifted and hardworking

Moving into the Era of Cancer Preemption

DORIS BROWNE

The Biomarker Development/Validation Criteria Group presented a schema to frame the research: 

• Identify a spectrum of biomarkers at various stages of the carcinogenic process, from normal to preneoplastic to neoplastic

• Consider multiple biomarkers for exposure, effect, and

specificity

• Establish criteria for biomarker validation and use

• Disseminate biomarker information to the scientific 

community

The Agent Development Criteria Group outlined the initial

junctures in development of preventive agents:

• Identify molecular targets and develop rational combinations of preventive agents

• Conduct preclinical/in vitro studies

• Conduct in vivo/animal studies

• Conduct Phase I/Phase II/Phase III studies

• Facilitate delivery from bench to bedside

The Group suggested maintaining flexibility and utilizing a

“go/no-go guide” in identifying criteria for getting past each

decision point. Also, in integrating biomarker information into

decision making at various steps, researchers must consider

issues related to type of agents, amount of agents, and validation of agents. The Group suggested that DCP broadly use the

NCI Cancer Therapy Evaluation Program and other NCI

committee resources, as well as pharmaceutical industry models of drug development.

The Enhancing the Agent Pipeline Group listed vital topics in

chemoprevention: 

• Cross-disciplinary agents, including statins, NSAIDs, and

vitamin D

• Molecular targeted agents with, for example, high throughput screening

• Epigenetic targets

• Accelerated development of functional foods

• Common targets and pathways that transcend cancer

across diseases

• Accelerated agent development

• Prevention endpoints in treatment trials

The Energy Balance/Obesity Group called for increased DCP

participation in the recently formed transdisciplinary NCI

Working Group on this topic. DCP initiatives will encompass

the spectrum of cancer research within basic science, clinical

trials, biorepositories, methodology, and animal models.

Expanding DCP’s involvement in this area would also include

a call for DCP requests for proposals; creating colloquia,

workshops, and an educational primer; and capitalizing on the

Community Clinical Oncology Program’s clinical trials network as a mechanism for diffusion of knowledge.

In closing the meeting, Dr. Greenwald announced the creation of three project teams to augment the work of existing

project teams: Agent Development, Biomarker Development,

and Energy Balance/Obesity. ■

Division of Cancer Prevention’s Inaugural Scientific Advances Symposium a Great Success continued from page 1

continued on page 9
The Staff Orientation Project Team was created by the

Division of Cancer Prevention at the annual All Hands

Retreat held May 4, 2000 in Annapolis, MD. At the time

of the retreat, there was no official orientation

process in place to facilitate the transition of new

personnel into the Division. Dr. Peter Greenwald,

DCP Director, charged staff with developing that

process. This new Staff Orientation Project Team

developed a mechanism to effectively expedite the

transfer of core information to new employees.

Since that time NCI has developed an orientation

class that all new employees are encouraged to

attend on their first day. The NCI Orientation

Program, coupled with the DCP Orientation materials in “hard copy” format and (in the near

future) on-line format, have successfully met the

needs of DCPs new recruits.

Under the leadership of the first project team leader, Judy

Smith, a DCP Employee Orientation Binder and a

Supervisors Pre-employment Checklist folder were developed.

The Orientation Binder is given to each new DCP permanent

(and, when requested, to non-FTE) employee. Over the years

the DCP Orientation Binder has evolved into what could be

considered a survival guide containing more general “how to”

and “where do I find” information. It is divided

into sections that cover accounts and passwords

needed to perform everyday activities, acronyms,

cafeteria locations, conference room reservations, email instructions, general information,

ITAS, Listserv information, organizational charts

and DCP floor plans, project team information,

DCP staff listings, helpful web sites, and helpful

information on the employee’s research group.

In the near future the Orientation Binder and

Supervisors Pre-employment Checklist will join

other resources for DCP employees on the DCP

web pages at http://www3.cancer.gov/

prevention/employees/index.html

Current members of the Staff Orientation Project Team

include Jennifer Gaegler (leader), Jim Crowell (Coordinating

Unit Sponsor), Linda Bremerman, Sara Hursen, Barbara

Redding, Ellen Richmond, and Linda Wong. ■

6 PreventionPOST SEPTEMBER 2003

Staff Orientation Project Team B Y JENNIFER GAEGLER, CONVEYED TO P REVENTION POST B Y GLORIA RASBAND

Prostate cancer is the most common non-dermatologic

cancer and the second leading cause of cancer death

among American men. It is estimated that, in 2003, there

will be 221,000 new cases and 29,000 deaths due to prostate

cancer in the U.S. despite recent advances in surgery, radiation

therapy, hormone therapy, and chemotherapy. On July 17,

2003, The New England Journal of Medicine published the

results of a landmark study known as the Prostate Cancer

Prevention Trial (PCPT): “The Influence of Finasteride on the

Development of Prostate Cancer” (Thompson, et al., N Engl J

Med 2003; 349: 215-224). This randomized, placebo-controlled, double-blind study demonstrated that finasteride, an

FDA-approved drug for the treatment of benign prostate

hypertrophy (BPH), reduced the seven-year period prevalence

of prostate cancer by nearly 25%.

Finasteride, a synthetic 4-azasteroid compound, is a specific

inhibitor of steroid 5α-reductase type II, an intracellular

enzyme that converts testosterone into 5α-dihydrotestosterone

(DHT), the most potent androgen and a major regulator of

prostate epithelial cell growth. Lowering DHT levels leads to

shrinkage of the enlarged prostate gland and improved urinary

function in most men with obstructive symptoms.

The Division of Cancer Prevention of the National Cancer

Institute supports all phases of chemoprevention agent development. Large, Phase III trials with definitive cancer endpoints,

such as the PCPT, represent the most important step in this

process. In this study, a total of 18,882 healthy men, aged 55

and older, were randomized to receive finasteride (5 mg/day) or

placebo for seven years. Participants were monitored quarterly

for side effects and adherence to treatment schedule. Prostate

biopsy was recommended if the annual prostate-specific hormone (PSA) level, adjusted for the effect of finasteride, exceeded 4 mg/ml, or if the digital rectal exam (DRE) was abnormal.

In addition, all men were asked to undergo an “end-of-study”

biopsy after 7 years on study, if they had not been previously

diagnosed with cancer and if their PSA and DRE remained

normal throughout the trial.

The primary endpoint of the trial was the seven-year period

prevalence of prostate cancer. Remarkably, the prevalence of

prostate cancer was reduced from 24% to 18% (relative risk

reduction of 24.8%, P <0.001), among men receiving finasteride. However, high-grade tumors, Gleason score 7-10, which

are typically more aggressive, were detected more frequently

among men receiving finasteride (6.4%) than among those

receiving placebo (5.1%). Further follow-up will be required to

determine whether the high-grade tumors diagnosed among

men receiving finasteride behave similarly to those diagnosed in

men receiving placebo. ■

Results of the Prostate Cancer Prevention Trial with Finasteride J A C OB KAGAN AND HOWARD PARNES
NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 7

Exfoliated Cells, Bioactive Food Components, and Cancer Prevention Workshop

CINDY DAVIS

Diet has been implicated in a myriad of diseases including

cancer. A large number of bioactive components in food

that are protective at different stages of carcinogenesis

in model systems have been identified. Although serum and

blood cells have frequently been used to evaluate the adequacy

of the diet, these measurements may not always predict effects

in target tissues. However, it is often difficult, if

not impossible, to obtain samples of the tissue

of interest in a noninvasive manner. Thus, there

is a need to utilize and validate surrogate markers that would be indicative of the accumulation and activity of bioactive food components

within cells of target tissues. Exfoliated or

sloughed cells may be useful to study the effects

of bioactive food components in target tissues.

To this end, the Division of Cancer

Prevention’s Nutritional Science Research Group

(NSRG) sponsored a one-day workshop entitled,

“Exfoliated Cells, Bioactive Food Components,

and Cancer Prevention,” on May 23, 2003 at

the Bethesda Marriott Hotel in Bethesda,

Maryland. The purpose of the workshop was to

identify and evaluate the strengths and weaknesses of using exfoliated cells for monitoring changes in gene

expression, DNA methylation, protein expression, and accumulation of bioactive components; and/or predicting the anticancer

effect in target tissues in response to essential and nonessential

nutrients. Participants in the workshop included clinicians, nutritionists. and cancer biologists. Because lung, colon, and breast

cancers are the three leading causes of cancer-related deaths in

the U.S., and because neoplasms at each of these sites have been

shown to be modified by dietary components, the workshop

focused on the utilization of exfoliated cells from these organs.

The gastrointestinal epithelium undergoes rapid renewal,

during the course of which millions of cells are shed into the

fecal stream. In fact, stool samples appear to yield a very large

quantity of intact epithelial cells: >10 million cells/gram of

feces. Changes in dietary habits, such as consumption of a high

fiber diet, can significantly increase the colonic epithelial cell

yield in the stool. Early studies also suggest that stool-based

DNA testing can detect supracolonic cancers, including those

of the lung, esophagus, stomach, pancreas, and bile duct

(workshop communication).

Lung epithelial cells can be obtained from sputum samples

or from bronchoalveolar lavage. Although sputum samples are

easier to obtain, cells present in sputum are primarily derived

from the large airways. In contrast, bronchoalveolar lavage is

useful for obtaining cells from the peripheral airways.

Exfoliated pulmonary epithelial cells may be

useful for the early diagnosis of cancer. For

example, aberrant p16 gene promoter methylation has been observed in sputum samples prior

to the clinical diagnosis of lung cancer (1).

Exfoliated epithelial cells from the lung have

also been utilized in nutritional studies.

Consumption of a lycopene-rich vegetable juice

has been shown to be associated with significantly decreased lung epithelial cell DNA damage in healthy volunteers as measured by the

COMET assay (2).

Cell sampling techniques from the mammary

gland do not appear to be as advanced as for

the colon or lung. Only a limited number of

cells can be recovered from the mammary gland

using nipple aspirate fluid and ductal lavage

techniques. One of the main questions addressed at the workshop concerned whether it is necessary to obtain samples from

the same duct in cancer prevention studies. If not, other breast

cell sampling techniques can be considered, including core needle biopsy or fine needle aspiration, which may yield more

cells. The choice of breast sampling technique for epithelial

cells will depend on the study question and local expertise.

Nevertheless, mammary epithelial cells present in nipple aspirate fluid have been utilized for cytology, DNA amplification,

DNA methylation, and protein expression.

Preparation of an Executive Summary from the workshop is

in progress. The summary will be available on the NSRG web

site: http://www3.cancer.gov/prevention/nutrition/index.html. ■

References

1. Harden SV, Tokumaru Y, Westra WH, et al. Gene promoter hypermethylation in

tumors and lymph nodes of stage I lung cancer patients. Clin Cancer Res 2003;

9:1370-1375.

2. Arab L, Steck-Scott S, and Fleishauer AT. Lycopene and the lung. Exp Biol Med

(Maywood) 2002; 227:894-899.

DCP home base: Executive Plaza 
Congratulations to Dr. Peter Greenwald

(OD) upon his election as Fellow of the

American Society for Nutritional Sciences.

Among many other accomplishments, his

selection was in recognition of his longtime

leadership in advancing the science of cancer prevention, especially as it relates to

nutrition. The awards ceremony was held

at the Experimental Biology Annual

Meeting in San Diego in April 2003.

Dr. Elizabeth Jeffery (NSRG) received the

Kenneth P. DuBois Award, given "in recognition of her contribution to the science

and practice of toxicology." It was presented at the Annual Spring Meeting of the

Midwest Regional Chapter of the Society

of Toxicology, held in Lincolnshire, Illinois,

in May 2003.

Dr. Leslie Ford (OD) received the 2003

NIH Director's Group Award as a member

of the Hormone Therapy Task Force. The

group was recognized at the Annual

Director’s Awards Ceremony in June for

“leadership related to the Hormone

Therapy Workshop with special focus on

planning, execution, and follow-up.”

The Uniformed Services University for

Health Sciences awarded Dr. Diane

Solomon (BGCRG) the University Medal

for "Distinguished Faculty." The medal

was presented in May 2003 for service to

the University as Adjunct Faculty for

Teaching. Dr. Solomon will also receive

the 2003 Papanicolaou Award from the

American Society of Cytopathology (ASC).

Given in recognition of lifetime contributions to the field of cytopathology, this

award is the ASC's highest honor.

The NIH Office of Evaluation awarded Dr.

Shine Chang (OPO) funding under the One

Percent Evaluation Set-Aside Program to

participate in a training course on

"Designing Effective Program Evaluations."

Gloria Rasband (OD) received the DCEG Special Recognition

Award for her continuing service in managing the Executive

Plaza South Library for DCCPS, DCEG, and DCP.

Kudos to everyone on these commendable accomplishments! ■

GLORIA RASBAND AND SUSAN N. PERKINS

DCP AWARDEES

8 PreventionPOST SEPTEMBER 2003

Dr. Peter Greenwald

Dr. Elizabeth Jeffery

Dr. Leslie Ford

Dr. Shine Chang

Dr. Diane Solomon

EDITORIAL

GROUP:

Susan Perkins

(Editor-in-Chief),

Cindy Davis,

Graça Dores, 

Grant Izmirlian,

Ann O’Mara

DESIGN/WEB

GROUP:

Doris Browne, 

Kathleen Foster

PRINTING/

DISTRIBUTION 

GROUP:

Jacob Kagan, 

Doug Midthune,

Gloria Rasband

The DCP Newsletter

Project Team 

welcomes 

new members 

Cindy Davis and 

Ann O’Mara!

PreventionPOST

DCP Newsletter Project Team

PreventionPOST

Newsletter of the Division of Cancer Prevention

National Cancer Institute

Executive Plaza North, Suite 3109

6130 Executive Boulevard, MSC-7361

Bethesda, Maryland 20892-7105

Back issues of the PreventionPOST may be seen online at

http://www3.cancer.gov/prevention/about.html#pp
NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 9

We would like you to join us in welcoming new staff to DCP:

DOUG MIDTHUNE

BEST WISHES TO: 

Dave Kausal recently retired from

the Prostate and Urologic Cancer

Research Group. He was also 

the photographer for the

PreventionPost, and we wish 

our colleague well in all his new

endeavors. ■

Dr. Graça Dores has joined the

Office of Preventive Oncology 

as Associate Director for Clinical

Prevention Research Training in the

Cancer Prevention Fellowship

Program (CPFP). She is a boardcertified hematologist/oncologist

who entered the CPFP as a Cancer

Prevention Fellow in 1999. Her

research interests include prevention of second primary cancers and

lymphohematopoietic cancers.

Dr. Padma Maruvada is a new 

Program Director in the Cancer

Biomarkers Research Group. She

joins DCP from the Intramural division of the National Institute of

Diabetes and Digestive and Kidney

Diseases.

Elaine Trujillo has joined the

Nutritional Science Research Group

as a nutritionist. She comes to DCP

from Boston, where she was the

Research Dietitian for the Metabolic

Support Service, Brigham and

Women’s Hospital, Harvard Medical

School. Elaine holds B.S. and M.S.

degrees in Nutritional Sciences from

the University of Delaware and

Texas Woman’s University, respectively. Over the past fifteen years

she has functioned as a clinical

nutritionist with a focus on critical illness, nutrition support, and obesity,

and during the past five years has

also been actively involved in clinical nutrition research that focuses

on markers of nutritional status

and nutritional supplements for

cancer patients.

TRANSITIONS

people are employed” at NCI and “how much people depend

on us to deliver products and services.” He wants to know specific things that he can do to help us do our jobs better. Dr. von

Eschenbach emphasized the importance of increasing the diffusion of research products into the clinical setting and shortening the timeline from bench to bedside. He is also committed

to collaborative efforts with the Food and Drug

Administration, concentrating efforts and reviews on research

trial design, infrastructure, and enabling technology, such as

bioinformatics, to enhance moving away from prevention

towards preemption through a seamless, integrated process.

Select DCP staff made presentations on “Arachidonic Acid

Metabolism as a Target for chemoprevention” - Eva Szabo

(LUACRG); “Agent Development Process/Toxicology/RAPID”

- Dr. Izet Kapetanovic (CADRG); “Phase III Prostate Cancer

Prevention Trials” - Dr. Howard Parnes (PUCRG); “Molecular

Profiling in Phase II Chemoprevention Trials” - Dr. Asad Umar

(GOCRG); and “Evaluating Biomarkers for Early Detection of

Cancer” - Dr. Stuart Baker (BRG). The Cancer Prevention

Fellowship Program was discussed by Dr. Doug Weed (OPO),

and two of its fellows made presentations, Dr. Jennifer EngWong on “Effect of Raloxifene on IGF Pathway in

Premenopausal Women at High Risk for Breast Cancer,” and

Dr. David Berrigan on “Transdisciplinary Approaches to

Energy Balance and Cancer Prevention.” The meeting closed

with a discussion and demonstration of the Protocol

Information Management System (PIMS) by Linda Parreco

(PIO) and Jen Flach (PIO). Dr. von Eschenbach then made a

tour of the DCP offices with Dr. Greenwald, who introduced

Division staff members.

We have been issued the “challenge goal” to eliminate suffering and death due to cancer by 2015. Our efforts and accelerated activities will help to attain this goal through discovery,

development, and delivery. These three components of the NCI

portfolio, if harvested appropriately, will provide significant

benefit to cancer patients and to the public at large. Kudos to

Dr. von Eschenbach and to the staff of DCP for its leadership

in the field of cancer prevention— and preemption. ■

Moving into the Era of Cancer Preemption continued from page 5
1 0 PreventionPOST SEPTEMBER 2003

Division of Cancer Prevention nurses presented the cancer

prevention message to the annual gathering of oncology

nurses this May 2003. The Oncology Nursing Society

(ONS) Congress accepted a proposal formulated by the DCP

Nursing Education Working Group on chemoprevention research

and clinical trials. ONS is the largest professional specialty nursing organization, with a membership of greater than 30,000 registered nurses and other healthcare providers. Its mission is to

foster “excellence in patient care, education, research, and

administration in oncology nursing.” The theme for this year’s

Congress, held in Denver, Colorado, was appropriately titled,

“Climbing Our Mountains.”

In an effort to increase awareness of the work of the Division,

the group developed a presentation on the importance of chemoprevention clinical trials in

decreasing cancer incidence. The

DCP Nursing Education Working

Group is comprised of Kathleen

Foster, Margaret House, Rose

Mary Padberg, Linda Parreco,

Ellen Richmond, Anne Ryan, and Judy Smith. The goal of this

group is to impart cancer prevention information to healthcare

professionals nationwide, thus utilizing the additional advantage

of informing nurses who often have established relationships with

communities and patients and their families. In the instance of

oncology nurses, their patients are often known to be at increased

risk for recurrent disease, or they may have an inherited cancer

risk, thus making them ideal candidates to participate in chemoprevention research.

Rose Mary Padberg provided

the introduction for the session

by explaining the mission of the

group and the experience of the

three speakers. Next, Linda

Parreco laid the foundation for

the ONS instructional session in

her presentation by defining the

meaning of cancer prevention.

She went on to depict current

public and professional perceptions, as well as misconceptions of the field of chemoprevention.

Linda outlined the Federal government’s role in the development

of prevention programs, and described the selection and testing of

agents for chemoprevention trials. Her talk concluded with an

explanation of the role of NCI and DCP in the development and

investigation of promising chemoprevention agents.

Ellen Richmond addressed the scientific evidence underlying

chemoprevention research. She described the current understanding of carcinogenesis, explaining the process from DNA mutation

through tumor formation and metastasis. Ellen went on to illustrate the important role of molecular targets in the development of

chemoprevention agents and completed her lecture with examples

of some of these key agents and their mechanisms of action.

Judy Smith rounded out the panel

presentation by describing how the

groundbreaking field of cancer prevention will impact the nursing profession. Describing important clinical

trials that changed the course of scientific thinking, Judy outlined the

path of discovery that chemoprevention research has taken through the

design and management of these

landmark trials. She further prepared

her listeners by providing web sites as educational resources for

future reference.

The information on chemoprevention was received enthusiastically by this audience of oncology nurses, many of whom have

been pioneers in the field of oncology nursing. Regrettably, the

experience of this group has frequently been with patients who are

at the end stages of

the disease spectrum.

A look at the future

of cancer prevention

provided a message of

hope for these health

care providers and

valuable information

to take back to the

communities in which

they practice. ■

Preventing Cancer: The Future of Cancer Nursing Practice

KATHLEEN FOSTER

Judith L. Smith, R.N., M.S.N.

Rose Mary Padberg, 

R.N., M.A.

Linda Parreco, Ellen Richmond,

and Judy Smith respond to

questions from the audience.

Kathleen Foster, Rose Mary Padberg, 

Margaret House, Anne Ryan, Ellen Richmond 

and Linda Parreco celebrate the success 

of their program.

Remember when? Although the dog days of summer are now upon us, only six months ago Executive Plaza was a winter wonderland.

Photos by Dave Kausal, February 5, 2003
NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 1 1

D A TE TOPIC DESCRIPTION WEBSITE

SEPTEMBER – JUNE 2003-2004 

JUNE 26-27, 2003

JUNE 23-25, 2003

JULY 7-AUGUST 1, 2003

JULY 31, 2003

3:00 P.M.,

LISTER HILL AUDITORIUM

AUGUST 4 - 8, 2003

AUGUST 17-22, 2003

OCTOBER 19-22, 2003

Colloquia Series 

Free Radicals: The Pros and Cons of

Antioxidants 

The Eighth Early Detection Research

Network Steering Committee 

Principles and Practice of Cancer

Prevention and Control Course 

Advances in Cancer Prevention

Lecture

Molecular Prevention Course 

Gordon Research Conference: New

Frontiers In Cancer Detection &

Diagnosis

All-Ireland Cancer Conference

Ireland-Northern Ireland - NCI Cancer

Consortium

The Office of Preventive Oncology

presents a Colloquia Series on

Wednesdays from 11:00 a.m. to noon. 

The purpose of this workshop is to

summarize current understanding of,

and identify major gaps in, our

knowledge about the role of antioxidants in cancer prevention and

tumor biology and their interactions

with conventional chemotherapy and

radiotherapy. 

Early Detection Research Network

Steering Committee met to share

information on current ongoing projects, including biomarkers validation

studies, EDRN development of bioinformatics tools, review of the EDRN

Associate members' contributions to

EDRN, and a workshop on "Moving

Biomarkers from Development to

Validation and Commercialization."

This annual four-week summer

course focuses on the concepts,

methods, issues, and applications

related to the principles and practice

of cancer prevention and control.

Participants have the opportunity 

to gain a broad-based perspective of

these subjects, including resources,

data, methods, and theories. 

Cancer Prevention: 

A European Perspective

Dr. Elio Riboli, International Agency

for Research on Cancer, Lyon, France 

This annual course provides a strong

background in the molecular biology

and genetics of cancer as well as an

overview of the basic laboratory

approaches applied to cutting-edge

research in the fields of molecular

epidemiology, bionutrition, chemoprevention, biomarkers, and translational research. 

Discussions focused on detection of

cancer and cancer risk using molecular profiling, proteomics, and epigenomics approaches, as well as different models and computational tools

for data analysis. 

The scientific conference will feature

distinguished speakers from

throughout Ireland, Northern Ireland,

and the U.S. It will be open to oncologists, researchers, nurses, students,

and other health care professionals

with an interest in learning about

and enhancing cancer research on

the island of Ireland.

http://www3.cancer.gov/

prevention/pob/fellowship/

colloquia.html

http://www3.cancer.gov/

prevention/frpca2003/

index.html 

http://www3.cancer.gov/

prevention/edrnsteering8/

index.html

http://www3.cancer.gov/

prevention/pob/courses/

principles.html

http://cancer.gov/prevention/pob

http://www3.cancer.gov/

prevention/pob/courses/

molprev.html

http://www.grc.uri.edu/

programs/2003/newfront.htm 

http://www.allirelandnci.org/new/

meetings.asp 

RECENT, ONGOING, AND UPCOMING DCP EVENTS
professionals from Northern Ireland, the Republic of Ireland,

and the NCI (including NCI-supported academic and research

institutions) to discuss state-of-the-art research findings for

selected topics in cancer prevention and control and to discuss

how these findings can best be translated into medical and

public health practice. These workshops will benefit both the

research and practice professional communities. The first of

these workshops took place in May 2003 and focused upon

smoking cessation and prevention. 

Acknowledgements

This article would not have been possible without the support

and encouragement of the Prevention Working Group of the

Consortium: Drs. Kevin Balanda, Ruth Barrington, Margaret

Boyle, Brian Gaffney, Fenton Howell, Scott Leischow, Elizabeth

Mitchell, Liam Murray, Patricia Riordan, and Kathy Rowe. 

Parts of this article were reproduced with kind permission

from the Health Promotion Agency for Northern Ireland.

Original article appeared in issue 18 of Promoting Health,

The Journal of Health Promotion for Northern Ireland,

December 2002. ■

Address for Correspondence:

Douglas L. Weed, M.D., M.P.H., Ph.D.

Dean, Education and Training

Chief, Office of Preventive Oncology

Director, Cancer Prevention Fellowship Program

Division of Cancer Prevention

National Cancer Institute

Executive Plaza North

Suite 3109

6130 Executive Blvd

Rockville, MD 20852

USA

Phone: 301-496-8640

Fax: 301-402-4863

E-mail: dw102i@nih.gov

References

1. Johnston PG, Daly PA. The NCI-Ireland Consortium: a unique international partnership in cancer care. Oncologist 2001; 6:453-458.

2. Walsh PM, Comber H, Gavin AT. All-Ireland Cancer Statistics: a joint report on

incidence and mortality for the island of Ireland. March, 2001. National Cancer

Registry (Ireland) and Northern Ireland Cancer Registry. 

3. Ireland-Northern Ireland-National Cancer Institute Cancer Consortium. Cancer

Research Across Borders. Annual Report 2000-2001.

1 2 PreventionPOST SEPTEMBER 2003

GRAÇA DORES

CART OON

Canacer Prevention and the All-Ireland-National Cancer Institute Cancer Consortium continued from page 2